Antidepressants associated with improvements in fibromyalgia symptoms

A meta-analysis published in the Journal of the American Medical Association demonstrated an association between antidepressants and improvements in pain, depression, fatigue, sleep, and health-related quality of life (HRQOL) in patients with fibromyalgia syndrome (FMS).

For this meta-analysis, the investigators screened entries from Medline (1966 through August 2008), PsycINFO (1966 through August 2008), Scopus (1980 through August 2008), and the Cochrane Library (1993 through August 2008). Studies were eligible if they used recognized criteria to define FMS, were randomized and controlled, and included antidepressants (tricyclic and tetracyclic antidepressants [TCAs], selective serotonin reuptake inhibitors [SSRIs], serotonin and noradrenaline reuptake inhibitors [SNRIs], or monoamine oxidase inhibitors [MAOIs]) as a treatment arm. Outcome measures included pain, fatigue, sleep, depressed mood, and HRQOL.

A total of 18 studies were included in the meta-analysis. Across these studies, reductions in pain (standardized mean difference [SMD], –0.43; 95% CI, –0.55 to –0.30; P.001), fatigue (SMD, –0.13; 95% CI, –0.26 to –0.01; P=.04), and depressed mood (SMD, –0.26; 95% CI, –0.39 to –0.12; P.001) were observed in antidepressant-treated patients versus placebo-treated patients. Improvements in sleep (SMD, –0.32; 95% CI, –0.46 to –0.18; P.001) and HRQOL (SMD, –0.31; 95% CI, –0.42 to –0.20; P.001) were also observed in the antidepressant group versus the placebo group. The effect of antidepressants was negligible for the outcome of fatigue and small for other outcomes.

Among antidepressant classes, TCAs were associated with significant improvements in pain (P.001), fatigue (P=.003), and sleep (P.001) outcomes. SSRIs were associated with improvements in pain (P=.04). SNRIs were associated with improvements in pain (P.001) and sleep (P.001) outcomes. MAOIs were associated with improvements in pain (P=.03). The authors stated that the results of this meta-analysis were not sufficient to demonstrate the superiority of 1 class of antidepressants over another.

The investigators discussed several limitations of their study. Because demographics, comorbidities, and comedication use of study patients were not reported, these factors may introduce a source of heterogeneity. Additionally, 6 published randomized, controlled trials were excluded from the study because the published data were not sufficient for the purposes of meta-analysis. The authors also stated that “the short duration of most studies and the lack of follow-up after treatment cessation leave unanswered whether antidepressants have long-term beneficial effects on FMS symptoms and the optimal treatment duration.” They added, “Since evidence for a long-term effect of antidepressants in FMS is still lacking, their effects should be re-evaluated at regular intervals to determine whether benefits outweigh adverse effects.”

Source
Hauser W, Bernardy K, Uceyler N, Sommer C. Treatment of fibromyalgia syndrome with antidepressants: A meta-analysis. JAMA. 2009;301:198–209.